An Unconventional Pharmacy That Gets Results: Bringing Integrative Medicine to the Pharmacy

OCTOBER 22, 2015
Dennis W. Song, RPh, CHC
Flower Mound Pharmacy and Herbal Alternatives is a different type of community pharmacy. From its name alone, you can see the pharmacy integrates both traditional pharmacy practice and alternative medicine modalities. The pharmacy itself looks like a cross between a full-service community pharmacy and a health food store.
 
In addition to dispensing prescriptions and compounded medications, the pharmacy offers specialty foods for patients who have food sensitivities (eg, gluten intolerance), a complete line of vitamin and herbal supplements, delivery service, private store accounts, diabetes management classes, and other disease state management programs. There are also separate private and semi-private rooms for nutritional, herbal, and pharmaceutical consultations. The pharmacy even features a clinical room that is used for various patient care services, such as immunizations and disease state testing.
 
There is a practicing nutritionist and lifestyle educator on staff who provide dietary planning and nutritional counseling. These services are complemented by a physical activity option that is based on a referral network of exercise trainers and physical therapists. Now, the pharmacist can offer specific recommendations when the doctor tells the patient to “eat right and exercise.”
 
All of these elements are integrated into the drug therapy program and become part of the patient’s total wellness plan. Outcomes and results, such as pounds lost and reduction of cholesterol and glycated hemoglobin (A1C) levels, are documented and communicated to the physician. It is one-stop shopping for health and wellness, all located in the pharmacy.
 
Connecting Clinical Outcomes and Drug Therapy
Flower Mound Pharmacy has a growing opportunity to offer services such as immunizations, blood pressure screening, and cholesterol and A1C testing because of the emerging health care models for reimbursement. Although these services are currently paid for by our patients, the pharmacy is preparing for true third-party payer reimbursement based on outcomes. Medicare Part D and the Affordable Care Act allow pharmacies to be compensated for medication therapy management (MTM) and improvement of certain quality adherence measures, but they are paid for completing the process and claims data, not for improving patient outcomes. The pharmacy has already proactively established the link between clinical outcomes and drug therapy. This has been accomplished through the measurement of reductions in cholesterol, A1C, and blood pressure seen with drug therapy and integration of supplements and lifestyle changes.
 
When starting therapy, patients bring in or physicians fax baseline blood work results to the pharmacy. A drug/supplement/lifestyle holistic treatment plan is implemented, and after 3 months, in-store testing for cholesterol and A1C are performed and the outcomes are assessed. The pharmacy has seen drastic reductions in A1C levels, averaging 1 to 5 points. Not only has this built loyalty among existing and newly referred patients to the pharmacy, it has increased profits with in-store testing, supplement sales, and improvement of adherence to drug therapy.
 
Patient-Centered Ambulatory Care
Based on the principle that “an ounce of prevention is worth a pound of cure,” the pharmacy practices a holistic, prevention-based approach to patient health. Whereas most pharmacies are reactive, “sick-based,” and product-driven, Flower Mound Pharmacy is a true patient-centered ambulatory care pharmacy practice. Its process has advanced to the stage where some local physicians include the patient’s lab work and medical history along with their prescription order so that the patient’s drug profile contains a record of all of their prescription medications and supplements. In fact, there are a few physicians who write prescriptions for the vitamin and herbal supplements and refer patients to the pharmacy.
 
Although Flower Mound Pharmacy staff realize that patients use different sources to get their prescriptions, the importance of a “pharmacy home” and a “primary care pharmacist” are conveyed to each patient. Medication history printouts are provided by the patients and incorporated into the pharmacy system. This gives the primary care pharmacist a comprehensive look at everything the patient is taking to treat their health condition. The pharmacist can now perform a complete and proper drug/supplement/disease-state screening for interactions and assess appropriate drug therapy.
 
Flower Mound Pharmacy aims to provide a variety of treatment options. The pharmacy serves as a health care epicenter that facilitates a true collaboration among health care providers from across the spectrum.Along with traditional prescriptions and compounded medications, our pharmacy specializes in therapeutic interventions that include vitamin and herbal supplements and therapeutic lifestyle changes. The pharmacy also offers alternative treatment modalities, such as acupuncture and biofeedback. It has a network of allopathic medical doctors (MDs), doctors of osteopathy (DOs), and alternative practitioners. Vital to the success of the model is naming a conventional MD or DO as the primary care provider and using the alternative practitioners, naturopaths, and therapists as “specialists.”
 
Bioidentical Hormone Replacement Counseling
The pharmacy specializes in bioidentical hormone replacement compounding. Working directly with approximately 24 physicians, nurse practitioners, and physician assistants, the pharmacy has established collaborative practice protocols. A standing order protocol format allows the pharmacist to reassess the patient, evaluate lab work that is faxed to the pharmacy, and initiate a hormone regimen. This service is welcomed by the physicians because it decreases the excessive administrative burden of nurses and medical assistants pulling charts and interrupting the patient work flow.
 
The dispensing workflow process includes a fax from the physician of the lab work and medical history instead of a traditional prescription. After a phone interview of the patient, recommendations for a compounded prescription are then made by the pharmacist. Risk factors are identified and mitigated, and a protocol prescription is faxed back to the physician. The compound can be started by the patient without having to wait for an “OK” from the physician. This protocol provides additional patient history, a second clinical assessment, and a double-check of appropriate hormone/drug therapy. After new hormone therapy is initiated, follow-up counseling is performed at the first refill, and all outcomes are reported to the physician. This process has been very well accepted by practitioners who want to provide compounded medications to their patients, but do not know how to prescribe them.
 
Like the patient-centered medical home, the pharmacy practice is an outcomes-based model that relies on patients to take ownership of their health. MTM is not just a transactional targeted medication review, but a true clinical management of the patient’s drug therapy. This is accomplished by compiling a complete medical history with lab values for high-risk patients. A pharmacy clerk has new responsibilities and serves as a “patient care coordinator,” similar to a nurse in a physician’s practice. He or she takes a record of the patient’s demographic information, medical history, and primary health concerns. Utilizing the term “patient goal” encourages the patient to become vested in their own health. The labs are obtained by the pharmacy from the patient or via fax or electronic communication from the physician. Possessing the patient’s medical history has now transformed pharmacists into practitioners. It is now very difficult to dispense a prescription without knowing if it is appropriate for that patient’s medical condition. Gone are the days of simply screening for allergies or drug interactions.
 
Challenges and Benefits
There have been both challenges and financial rewards from using this new model. Community pharmacy revenue has traditionally seen reimbursement from prescription fees, which have been progressively shrinking. Flower Mound Pharmacy takes a 3-pronged approach—comprising prescription fees, OTC and dietary supplement sales, and clinical services and consulting fees—to ensuring its long-term financial sustainability.
 
Revenue from prescriptions accounts for more than 70% of total gross revenue, but provides less than 10% of gross profit; most of the operating and gross profit are generated from vitamin and supplement sales. Scheduled private consultations paid for by the patients provide an additional $12,000/year in revenue. In addition, these consultations drive dietary supplement sales, which amount to more than $250,000/year.
 
A true and measureable impact on our health care system can be achieved by improving the lifestyle habits of each patient. Therefore, the biggest challenge going forward is to have third-party insurance payers realize the value in health care savings achieved by the preventive measures patients take that lead to improved health outcomes. The pharmacy believes that the patient must be personally invested in their own health and make therapeutic lifestyle changes. Drugs and medications only alleviate symptoms and manage disease states, primarily by reducing modifiable risk factors such as blood pressure, cholesterol, and blood sugar levels. Regardless of the causes of a medical condition, prevention and adherence to the treatment plan mitigate risk factors. Flower Mound Pharmacy utilizes services such as medication synchronization, behavioral interviewing during counseling sessions, and incentive and reward programs to motivate their patients to lead healthy lives.
 
Typically, retail community pharmacies generate most of their income during the winter cold and flu seasons. Flower Mound Pharmacy has changed the paradigm to a sustainable prevention-based model that ensures a continual traffic flow from patients who take a vested interest in their health. This is a unique pharmacy that the public visits to stay healthy, not just get well.
 
Flower Mound Pharmacy is not just a retail dispensing pharmacy, it is a community pharmacy practice that is education-based and outcomes-driven. In a world where we are drowning in information and starving for knowledge, Flower Mound Pharmacy provides the education, resources, and tools to help our patients lead healthy, happy lives.


Dennis Song, RPh, CHC, is the owner and head pharmacist of Flower Mound Pharmacy, a wellness-oriented local pharmacy with an integrative approach to health through medicine, supplements, nutrition, and alternative therapies in the North Dallas-Fort Worth area. Dennis and Kathy, his wife, opened Flower Mound Pharmacy over 18 years ago with the goal of providing patients a reliable source of information, support for their health concerns, and unique services. Some of the distinct services the pharmacy offers include compounded prescriptions, integrated natural and alternative treatments, prevention and education programs, and specialty foods for people with dietary allergies. Residents voted the store the 2014 Best Pharmacy in Denton County. Additionally, Song continues to be actively involved in the Texas Pharmacy Association, having served as its president from 2011 to 2012. In 2012, the American Pharmacists Association Foundation and Student Affairs Administrators in Higher Education awarded Dennis the Bowl of Hygeia, an annual award recognizing civic and community leadership among pharmacists. 



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